Some Fear Clinic Closures Would Shut Out Neediest : Funding: Administrative problems threaten neighborhood medical and mental health facilities, which serve many who might not be able to travel to county hospital in Ventura.

With a bad back and no car, Maria Ortiz has enough difficulty getting from her home to her neighborhood medical clinic seven blocks away.

Now the 66-year-old Santa Paula woman worries the clinic might close, forcing her and others in the area to seek treatment at the county hospital in Ventura, where their Medicare insurance is accepted.

The Santa Paula facility and 22 other county medical and mental health clinics are in danger of losing millions of dollars in federal Medicare reimbursements and other funding because of a host of organizational and administrative problems uncovered by recent audits.

The result is that some clinics could be shut down and patient services scaled back, a move doctors and officials say would hamper efforts to provide preventive care in some of the county’s poorest communities.

“We provide services to people who would not go to the doctor at all if it were not for their neighborhood clinic,” said Dr. Connell Davis, who runs the Santa Paula Clinic. “Their medical problems could become much worse.”

Davis, three other doctors and two nurses serve about 100 patients daily. She said she fears clients such as Ortiz would not seek medical treatment if they had to travel to Ventura.

“Most of our patients have no transportation at all,” Davis said. “They walk or take the bus. They walk here with their children in strollers. They come here in wheelchairs.”

The U.S. Health Care Financing Administration contends the Santa Paula Clinic and other outlying facilities operate independently from the Ventura County Medical Center and therefore do not qualify for the hospital-based Medicare rate. That rate brings in about $2 million more annually than if the clinics were declared free-standing.

County officials maintain the clinics are outpatient satellites of the public hospital and have appealed the federal decision to the Department of Health and Human Services in Washington.

“It is crucial to put clinics in the community, where the people who need them are living. These are low-income people who don’t have cars and are barely squeaking by,” Supervisor John Flynn said. He will ask his colleagues Tuesday to join him in soliciting the help of top-ranking federal officials in obtaining an exemption for the county’s clinic system.

Flynn said he is especially concerned about the future of the county’s 14 mental health clinics in light of the possible funding loss stemming from the state audits.

State Sen. Cathie Wright (R-Simi Valley), who helped create the Ventura statewide model for treating the mentally ill, has vowed a fight to withhold $5.3 million the county receives for operating innovative programs because she believes the system has deteriorated.

The potential losses compound the county’s financial troubles stemming from the failed merger of its mental health and social service departments last year. County supervisors voted in December to rescind their action after federal officials determined it violated organizational rules.

Several state and federal audits were launched after the merger was dismantled. One investigation uncovered nearly 10 years of faulty billing practices within the mental health department. To settle that matter, the county has agreed to pay $15.3 million to the U.S. attorney’s office.

That loss alone could mean the end of crucial programs, including a county homeless shelter, and delay funding for a badly needed Juvenile Hall.

Now Flynn is attempting to cap the financial losses by calling for a “battle plan” to save the $2 million in health clinic money. His plan involves seeking the help of U.S. Democratic Sens. Dianne Feinstein and Barbara Boxer, Health and Services Secretary Donna Shalala and even Vice President Al Gore and his wife, Tipper, a mental health advocate.

Bill Wood, an administrator who runs the county’s medical clinics, said the patients would ultimately suffer if the county loses the funding.

“It’s going to create a cash-flow problem,” Wood said. “We’re still providing the same services to the patients, but it’s going to become very difficult to continue to do so. We’re hoping there won’t be a loss.”

Irma Lopez, 39, Ortiz’s daughter, who also lives in Santa Paula, said she and other family members take a bus whenever they must go to the Ventura County Medical Center. She said they must transfer several times and the trip takes a few hours.

Lopez said she likes the familiarity of the neighborhood clinic, where she sees the same friendly doctor and doesn’t feel like she’s being rushed.

“My doctor at the clinic takes time to talk to my kids,” Lopez said. “She takes their hands in hers and makes them feel comfortable.”

Officials, clients and social workers at mental health care clinics in the outskirts of Ventura County are also concerned over the possible loss of funding.

Dennis Cain, an administrator who runs the county’s mental health clinics, said a $2-million loss would result in a cut to client services. And an additional loss of $5.3 million per year in state funding would be detrimental, he said.

“It would be painful if we were to lose that money,” he said. “At this point, I don’t even know what that would mean to our clinics. A huge piece of that state funding goes into the clinics.”

Garland Jones, 41, for one, said he doesn’t know what he would do without his community clinic in Thousand Oaks. Jones, a schizophrenic, visits the clinic several times a week.

That facility, Conejo Valley Mental Health Clinic, is nearly 30 miles from the county hospital, and is earmarked to receive a decrease in funding.

On Wednesday, Garland and about a dozen other clients attended the clinic’s socialization program, where they cooked a pasta lunch and sat around talking and eating.

“It’s hard to make friends,” said Jones, sipping a diet soft drink and finishing a word-search puzzle. “This is about the only place where I feel comfortable.”